Iv antibiotic running as primary?

[SquatsNScrubs, BSN, RN]

Perhaps I am overthinking this, but alas...

I've recently noticed on my floor patients who are not receiving continuous IV fluids having IV antibiotics run as the primary on the pump. No small bag of normal saline is being used as the primary with the antibiotic as the piggyback. There is approximately 13mL in the distal primary tubing. This means that a patient who is receiving a 50 mL antibiotic is missing out on almost a third of their dose left behind in the tubing...right?

I am relatively new at my facility and am unsure how to go about this. If I see an antibiotic being run as the primary, I will swap the old abx bag for a 100 mL bag of NSS and run the abx as the secondary.

Should I send an email to my manager? I can't find a policy regarding this.

[EDNURSE20, BSN]

I've only ever heard of giving ivabs as a primary. I've never seen them been piggyback. I wouldn't say anything as it's normal practise. If you really want to you will need to do a lot of research to prove your way is indicted as best practise to justify the change. Making all nurses change this habit is a big job.

[mi_dreamin, BSN]

I am a very new nurse so I have very limited experience but where I work we never hang antibiotics with fluids unless both are prescribed. It seems the providers at my (and apparently your) facility do not think it is super important that the patient receives that last 13ml.

Unless you know of (or are willing to conduct) specific studies that demonstrate better patient outcomes when IV antibiotics are run secondary to fluids I personally would not worry about it.

Also, if the patient has a condition like CKD or CHF, additional fluids could possibly exacerbate their condition.

Just my 2 cents, curious to see what others think though...

[Night__Owl, BSN, RN]

I spike all mine as secondary behind a small bag of NS at KVO for the simple fact that I can return in an hour and 15 minutes or so to saline lock it, rather than having to drop what I'm doing because the pump is alarming and waking up my patients. (An extra 5 or 10 mls of NS is not going to throw off a CHF or CKD patient.)

[MunoRN, RN]

It's been the expected practice at every place I've worked to hang antibiotics as a secondary even if there are no primary fluids ordered. This is facilitate giving the full dose of antibiotic by using the primary fluid to prime the line initially and then to flush the line after the antibiotic has infused. Obviously this is more clinically significant if you're talking about 50ml bags of antibiotics compared to a 500ml antibiotic.

One place I worked did an informal study on how much fluid gets lost when using just primary tubing, nurses who didn't feel like they were wasting much fluid in priming the line were actually wasting about 15mls, and then there's about 15mls left in the tubing, so that means that out of a 50ml bag of antibiotics the patient is only getting 20mls, which means they not only aren't getting the ordered dose but this underdosing also facilitates antibiotic resistance.

[CalicoKitty, BSN, MSN, RN]

It also will depend on if you're using the tubing for future doses. The first dose would be short, but subsequent doses with the same tubing should give the correct amount. This situation can also happen with electrolytes, and those aren't usually given too often.

When I'm on the floor, we almost always use secondaries for most infusions. In the ER, they often run abx in primaries. They have suggested flushing the line with saline before disconnecting and discarding the tubing to help ensure the full amount is given or less wasted.

[Been there,done that, ASN, RN]

This is a good question. A question for pharmacy and the prescribing physician.

[Rose_Queen, BSN, MSN, RN]

Due to the recent IV fluid shortage, we switched to all meds as primary if no maitenance fluids are ordered. The 13mL left in the tubing is solved by connecting a 20mL flush syringe as a piggyback after the medication is infused.

[beekee]

Due to the recent IV fluid shortage, we switched to all meds as primary if no maitenance fluids are ordered. The 13mL left in the tubing is solved by connecting a 20mL flush syringe as a piggyback after the medication is infused.

How do you do that?

[applewhitern, BSN, RN]

Not all primary IV tubing is 15cc; some are much greater. The usual ones we use are 27cc, and I've seen some greater than that. I always hang a primary to push the piggyback med thru and ensure the patient gets it all. I set the pump to give a flush, depending on the tubing. For instance, my flush will usually be 27cc.

[LovingLife123]

We run antibiotics as a primary. I prime the the tubing with normal saline. I then run the antibiotic and run a flush of normal saline behind. All medication gets to the patient and none is lost through the priming process.

[applewhitern, BSN, RN]

How do you do that?

Some IV pumps are the type you can just screw a luer-lock syringe onto, thus, you can easily give a flush of whatever amount you want to. The ones I've used like this were PLUM, I think.